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1.
J Hand Surg Asian Pac Vol ; 27(2): 261-266, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1840617

ABSTRACT

Background: Management of hand trauma has evolved to incorporate assessment, treatment and rehabilitation of patients in a 'one-stop' clinic on initial presentation. Our aim was to evaluate the effect of coronavirus disease 2019 (COVID-19) on the choice of treatment for hand fractures using inter-rater agreement between surgeons. Methods: All patients with hand fractures during the COVID-19 lockdown from March to May 2020 were included in the study. Two experienced hand surgeons blinded to management and outcomes independently reviewed radiographic images and relevant clinical history to provide their opinion on optimal treatment. Weighted kappa analysis was performed to determine concordance and inter-rater agreement between the two surgeons and actual management. Results: The study included 82 patients (62 men and 20 women) with a mean age of 40.3 (SD 19.7). The injuries occurred most often at home following an accident (34%) or a fall (28%). Fractures involved the metacarpals in 29 patients and the distal phalanx in 22 patients. Thirty-five patients underwent surgery, whereas 47 were managed conservatively. Overall agreement between actual management and consultant A and consultant B was moderate (κ = 0.55, p < 0.0001 and κ = 0.63, p < 0.0001, respectively). Subgroup analysis showed a weak agreement between actual management of metacarpal fractures and consultant A and consultant B (κ = 0.22, p = 0.29 and κ = 0.47, p = 0.02, respectively). Inter-rater agreement was substantial for management of metacarpal fractures (κ = 0.73, p < 0.0001), but weak for distal phalanx fractures (κ = 0.29, p = 0.03). Conclusion: Our study has shown that overall management of hand fractures remained optimised throughout the pandemic. However, a lack of concordance was observed in the management of metacarpals. Level of Evidence: Level IV (Therapeutic).


Subject(s)
COVID-19 , Fractures, Bone , Hand Deformities , Adult , Communicable Disease Control , Female , Fractures, Bone/diagnostic imaging , Fractures, Bone/epidemiology , Fractures, Bone/surgery , Humans , Male , Observer Variation , Reproducibility of Results
2.
Sci Rep ; 12(1): 6528, 2022 Apr 20.
Article in English | MEDLINE | ID: covidwho-1805654

ABSTRACT

This study aimed to investigate the association between COVID-19 and fracture risk and provide a targeted reference for the world through China's experience. A nationally representative sample of COVID-19 prevalence areas selected using stratified random sampling was retrospectively analyzed. Age, sex, fracture site, mechanism of injury, and concurrent fractures of traumatic fracture patients in selected hospitals were collected from 10 January to 10 July 2020. The epidemiologic characteristics of traumatic fractures and the association between COVID-19 and fracture risk were explored using descriptive epidemiological methods and a distributed lag nonlinear model. A total of 67,249 patients (52.3% males, 49.4 ± 19.4 years old) with 68,989 fractures were included. The highest proportion of fractures were in the tibia and fibula (14.9%), followed by the femur (13.6%) and ulna and radius (12.5%). Low-energy fractures accounted for 23.3%. With the increase in newly confirmed COVID-19 cases, fracture risk decreased for children, young and middle-aged adults, elderly men, high-energy fractures, and residents in regions with < 1000 cumulative confirmed COVID-19 cases. Fracture risk decreased sharply in all residents except elderly women, for low-energy fractures, and in regions with > 1000 cumulative confirmed COVID-19 cases when newly confirmed COVID-19 cases increased in China. Primary (home) prevention measures are emphasized to prevent traumatic fractures.


Subject(s)
COVID-19 , Fractures, Bone , Adult , Aged , COVID-19/epidemiology , Child , China/epidemiology , Cities/epidemiology , Female , Fractures, Bone/epidemiology , Fractures, Bone/etiology , Humans , Incidence , Male , Middle Aged , Retrospective Studies
3.
Arch Osteoporos ; 17(1): 68, 2022 Apr 18.
Article in English | MEDLINE | ID: covidwho-1797533

ABSTRACT

Fracture hospitalizations of people ≥ 65 years old living in France increased annually from 2015 until 2019 (average: 1.8%), until being reduced in 2020 (- 1.4%) with an abrupt decrease during the lockdown period. Decreased exposure to the risk of falling during COVID-19 year 2020 may have reflected in lower incidence of fractures.


Subject(s)
COVID-19 , Fractures, Bone , Aged , Communicable Disease Control , Fractures, Bone/epidemiology , Hospitalization , Humans , Prevalence
4.
J Am Acad Orthop Surg Glob Res Rev ; 6(4)2022 04 08.
Article in English | MEDLINE | ID: covidwho-1786226

ABSTRACT

BACKGROUND: The COVID-19 pandemic resulted in closure of schools and playgrounds while requiring social distancing, changes that likely affected youth sports participation. The purpose of this study was to identify changes in the epidemiology of pediatric sports injuries during the COVID-19 pandemic. METHODS: This retrospective cohort study included patients between the ages of 4 and 18 years who presented to orthopaedic clinics within a single children's hospital network with an acute injury sustained during athletic activity between March 20, 2020, and June 3, 2020 (the strictest period of state-level shelter-in-place orders). These patients were compared with those within the same dates in 2018 and 2019. Chi square and Mann-Whitney U tests were used, as appropriate. RESULTS: Significantly less sports injuries were seen during the pandemic (n = 257) compared with the same dates in 2018 (n = 483) and 2019 (n = 444) despite more providers available in 2020 (P < 0.001). During the pandemic, patients with sports injuries were younger (median age 11 versus 13 years, P < 0.001) and had less delay in presentation (median 5 versus 11 days, P < 0.001). A higher proportion were White (66.9% versus 47.7%, P < 0.001), privately insured (63.4% versus 48.3%, P < 0.001), and seen at a nonurban location (63.4% versus 50.2%, P < 0.001). Most sports injuries during the pandemic were fractures (83.7%). Although 71.4% of all injuries in the prepandemic period occurred in the context of formal sports, only 15.2% were sustained in a formal athletic context in 2020 (P < 0.001). The frequency of surgical treatment was higher during the pandemic (14.8% versus 7.8%, P = 0.001), mainly because most of these injuries were fractures requiring surgical intervention. CONCLUSIONS: Fewer sports injuries were seen in the outpatient setting during the COVID-19 pandemic, and most of these injuries were fractures and occurred outside of organized sports settings. Patients were more likely to be White, privately insured, and seen at a nonurban location.


Subject(s)
Athletic Injuries , COVID-19 , Fractures, Bone , Youth Sports , Adolescent , Athletic Injuries/epidemiology , COVID-19/epidemiology , Child , Child, Preschool , Fractures, Bone/epidemiology , Humans , Pandemics , Retrospective Studies
5.
Med Oral Patol Oral Cir Bucal ; 27(3): e223-e229, 2022 May 01.
Article in English | MEDLINE | ID: covidwho-1776516

ABSTRACT

BACKGROUND: The coronavirus pandemic has impacted health systems worldwide, with Spain being one of the most affected countries. However, little is known about the extent to which the effects of staying home, social distancing, and quarantine measures have influenced the epidemiology of patients with maxillofacial trauma. The aim of this study was to analyze the impact of the coronavirus pandemic on the incidence, demographic patterns, and characteristics of maxillofacial fractures in the largest hospital in southern Spain. MATERIAL AND METHODS: Data from patients who underwent surgery for maxillofacial fractures during the first year of the pandemic between 16 March 2020 and 14 March 2021 (pandemic group) were retrospectively compared with a control group during the equivalent period of the previous year (pre-pandemic group). The incidence was compared by weeks and by lockdown periods of the population. Demographic information, aetioloy, fracture characteristics, treatment performed, and days of preoperative stay were evaluated. Descriptive and bivariate statistics were calculated (p<0.05). RESULTS: During the first year of the pandemic, there was a 35.2% reduction in maxillofacial fractures (n=59) compared to the pre-pandemic year (n=91, p=0.040). A significant drop was detected during the total home lockdown period of the population (p=0.028). In the pandemic group, there was a reduction in fractures due to interpersonal aggressions, an increase in panfacial fractures, a significant increase in other non-facial injuries associated with polytrauma (p=0.037), a higher number of open reduction procedures with internal fixation, and a significantly longer mean preoperative stay (p=0.016). CONCLUSIONS: The first pandemic year was associated with a decline in the frequency of maxillofacial trauma and a change in the pattern and characteristics of fractures. Inter-annual epidemiological knowledge of maxillofacial fractures may be useful for more efficient planning of resource allocation and surgical practice strategy during future coronavirus outbreaks and population lockdowns.


Subject(s)
Coronavirus , Fractures, Bone , Maxillofacial Injuries , Fractures, Bone/epidemiology , Humans , Maxillofacial Injuries/epidemiology , Maxillofacial Injuries/etiology , Maxillofacial Injuries/surgery , Pandemics , Retrospective Studies , Spain/epidemiology
6.
J Hand Surg Eur Vol ; 47(6): 605-609, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1650998

ABSTRACT

In response to the coronavirus pandemic the British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) guidelines advised treating distal radial fractures non-operatively where possible. A cohort was studied retrospectively to assess whether the COVID pandemic lockdown within the UK altered types, the management and complications of paediatric distal radial fractures. The cohort studied comprised of 194 paediatric distal radial fractures in the pre-COVID cohort and 101 fractures in the COVID cohort. There was no significant differences in the type of fractures in the two cohorts. Significantly more high energy injuries were sustained among the COVID cohort than the pre-COVID (p < 0.001). The COVID cohort had significantly more patients managed in cast (p < 0.001) and significantly more managed with K-wire fixation (p = 0.049). The COVID cohort had significantly more complications (p = 0.016) at minimum 10-month follow-up. The results suggest that treatment of paediatric distal radial fractures during lockdown was too conservative and subsequent complications may put additional strain on orthopaedic services.Level of evidence: IV.


Subject(s)
COVID-19 , Fractures, Bone , Radius Fractures , Bone Wires/adverse effects , COVID-19/epidemiology , Child , Communicable Disease Control , Fractures, Bone/epidemiology , Fractures, Bone/surgery , Humans , Radius Fractures/epidemiology , Radius Fractures/surgery , Retrospective Studies
7.
BMC Musculoskelet Disord ; 22(Suppl 2): 1060, 2021 Dec 30.
Article in English | MEDLINE | ID: covidwho-1631207

ABSTRACT

BACKGROUND: The purpose of the study is to evaluate the use of the suprapectineal quadrilateral surface (QLS) plates associated with the anterior intrapelvic approach (AIP) to the acetabulum in the surgical treatment of acetabular fractures with anterior involvement. METHODS: We did a retrospective study of patients surgically treated with QLS plates and AIP for acetabular fractures with the involvement of the anterior column, between February 2018 and February 2020, in our Hospital. The following data were recorded: mechanism of injury, the pattern of fracture, presence of other associated injuries, the time before performing the surgery, surgical approach, position on operating table, time of surgery, intraoperative bleeding, hospitalization time, intraoperative and postoperative complications. Follow-ups were performed at 1, 3, 6, 12 months, then annually. The clinical-functional outcome was assessed with the Merle d'Aubigne Postel score (MAP) modified by Matta; while the radiological outcome with the Matta Radiological Scoring System (MRSS). A Chi-square test was utilized to examine associations between parametric variables. RESULTS: We included 34 patients, mean age 62.1, with an average follow-up of 20.7 months. The most frequent traumatic mechanism was road trauma. There were 15 isolated anterior columns and 19 associated patterns. There were 5 cases of associated visceral injuries, and 10 cases of other associated skeletal fractures. All patients were in the supine position. The surgical approach used was the AIP in all cases, with the addition of the first window of the ilioinguinal approach in 16 cases and of the Kocher-Langenbeck approach in 2 cases. The average time before performing the surgery was 8.5 days. The mean time of the surgery and the mean length of stay after surgery were 227.9 min and 8.2 days, respectively. There weren't cases of intra-operative complications, while there were postoperative complications in 5 patients. The MRSS was judged anatomical in 26 cases, imperfect in 7 cases and poor in 1 case. The average MAP value was 15.2. We observed a significant relationship between the radiological outcome and the clinical outcome (p < 0.05). CONCLUSIONS: The QLS plates in association with the AIP approach represent an effective treatment strategy for the treatment of acetabular fractures with anterior involvement.


Subject(s)
Fractures, Bone , Hip Fractures , Acetabulum/diagnostic imaging , Acetabulum/surgery , Bone Plates , Fracture Fixation, Internal/adverse effects , Fractures, Bone/diagnostic imaging , Fractures, Bone/epidemiology , Fractures, Bone/surgery , Humans , Middle Aged , Retrospective Studies , Treatment Outcome
8.
Eur J Pediatr ; 181(4): 1473-1480, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1620262

ABSTRACT

The COVID-19 pandemic led to fundamental changes in daily routines of children. Our aim was to evaluate the incidence and characteristics of fractures among Israeli children during 2020 compared with 2015-2019. Demographic, clinical data, and incidence rates of fractures in individuals aged < 18 years were derived from the electronic database of Meuhedet Health Services, which provides healthcare services to 1.2 million people in Israel. We further subdivided the year to five periods according to government regulations of lockdown and isolation at each period. Fracture sites were determined according to ICD9 definitions. During 2020, 10,701 fractures occurred compared with 12,574 ± 599 fractures per year during 2015-2019 (p-value < 0.001). Fracture rates were lower during all periods in 2020. The largest decline was observed during the first lockdown for both boys (56% decline, 95% confidence interval [CI] 52-60%) and girls (47% decline CI 41-53%). While the fracture rate declined for most age groups, the largest decline was recorded for the age group 11-14 years, with significant reduction rates of 66% (CI 59-71%) for boys and 65% (CI 54-73%) for girls. The most prominent declines were of fractures of the hand bones of both boys and girls (64% and 59%, respectively). Conclusions: Our data showed a significant decrease in fracture rate in 2020 compared to the previous 5 years, as well as differences between periods within that year. What is New: •The COVID-19 pandemic led to fundamental change in daily routines of children with significant decrease in school attendance and sport activities. •Consequent to these public health measures, the incidence rate of pediatric fractures decreased significantly. What is New: •This study demonstrates declines in fracture rates during lockdown periods, with only partial reversing of the trends between the lockdown periods. •The most pronounced decline was observed during the first lockdown period. •The decline was most prominent in children aged 11-14 years; there was no significant change in fracture incidence of children aged <3 years.


Subject(s)
COVID-19 , Fractures, Bone , Adolescent , COVID-19/epidemiology , COVID-19/prevention & control , Child , Child, Preschool , Cohort Studies , Communicable Disease Control , Female , Fractures, Bone/epidemiology , Fractures, Bone/etiology , Humans , Incidence , Male , Pandemics
9.
Acta Orthop Traumatol Turc ; 55(5): 439-443, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1502685

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate whether COVID-19-related period of societal restrictions and nationwide in 2020 were associated with a significant change in types and frequency of traumatic fractures. METHODS: A systematic review of recent literature on epidemiologic characteristics of traumatic fractures during the outbreak of COVID-19 was conducted. Multiple databases of PubMed, EMBASE, Cochrane library, and Web of Science were searched, and articles comparing incidence for traumatic fractures before and after of COVID-19 outbreak were Results: From 8 published studies which had been reported from July 2020 to September 2020, a total of 9305 patients were identified. The study period of each study included varied from January 24 to May 22 in 2020. There was a significant decrease in the total number of trauma cases during lockdown by 3229 cases (pre-lockdown n = 6267 and lockdown n = 3038), amounting to a decrease by a pooled percentage of 51.6% (P = 0.012). The incidence of hand and tibia fractures decreased while the incidence of femoral fracture significantly increased during COVID-19 outbreak (P < 0.001). There was no significant difference in the fracture frequency for all other skeletal areas (P > 0.05). CONCLUSION: Evidence suggests that there was a significant decrease in the overall number of traumatic fractures during the COVID-19-related period of societal restrictions and lockdown. Proportions of most fractured areas were not significantly influenced by the state of emergency, except for femoral fractures, which had occurred more often during this state. Care must be taken, while developing contingency plans for reallocating resources during the COVID-19 pandemic, not to assume that all trauma presentations will decrease. Evidence from this study has suggested there was a significant decrease in the overall number of traumatic fractures during the COVID-19-related period of societal restrictions and lockdown. Proportions of most fractured areas were not significantly influenced by the state of emergency, except for femoral fractures which had occurred more often during this state. LEVEL OF EVIDENCE: Level III, Diagnostic Study.


Subject(s)
COVID-19 , Fractures, Bone , Communicable Disease Control , Fractures, Bone/epidemiology , Humans , Pandemics , SARS-CoV-2
10.
Medicine (Baltimore) ; 100(35): e27166, 2021 Sep 03.
Article in English | MEDLINE | ID: covidwho-1393507

ABSTRACT

ABSTRACT: In 2019, the Coronavirus disease 2019 (Covid-19) was reported in Wuhan, China. Governments in various countries had taken many safeguards. This study investigated the incidence of orthopedic trauma in a rural region epidemiologically and guided source distribution and medical professionals to sustain healthcare systems.Between December 2019 and August 2020, 1651 patients admitted to orthopedics and traumatology clinics with trauma were evaluated in this study. Patients were grouped into 3 groups: pre-covid, restriction, and permitted groups. Age, sex, and fracture types of patients were recorded.The number of patients in the pre-covid period was 629 (38.1%), those were 334 (20.2%) in the restriction period, and 688 (41.7%) patients were admitted in the permitted period. A total of 1203 (72.9%) patients with upper extremity fractures, 383 (23.2%) patients with lower extremity fractures, and 65 (3.9%) patients with axial skeleton and pelvic ring fractures were included in the study. The lowest rates were found in the restriction period when all fractures were evaluated according to the admission periods. There were significant differences between admission dates and the fractures (P < .001).In this study, a decrease in orthopedic trauma rates was observed by half in the restriction period compared with the other 2 periods. Public health precautions had led to a reduction in the incidence of orthopedic trauma in all age groups.


Subject(s)
Communicable Disease Control , Fractures, Bone/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/prevention & control , Child , Child, Preschool , Female , Humans , Incidence , Infant , Infant, Newborn , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Turkey/epidemiology , Young Adult
11.
J Pediatr Orthop B ; 31(1): e56-e64, 2022 Jan 01.
Article in English | MEDLINE | ID: covidwho-1361809

ABSTRACT

This study aims to establish how pediatric fracture patterns were altered at a level 1 trauma center in a state that implemented a shutdown during the initial height of COVID-19. After IRB approval, we identified 2017 patients treated at a pediatric institution for definitive management of a fracture between 26 March and 31 May 2018, 2019, or 2020. Dates were chosen based on statewide stay-at-home orders for Colorado. Patients were excluded for treatment at another institution (n = 148), no fracture noted in clinic (n = 18), or other (n = 13). Data were retrospectively collected from the remaining 1838 patients regarding demographics, fracture injury, mechanism, and treatment. Odds ratios (ORs) were calculated for each variable during COVID-19 relative to prior years. The number of fractures during 2020 decreased by 26% relative to 2019 and 23% to 2018. A larger proportion of patients experienced at least a 5-day delay to definitive treatment [OR: 1.55, confidence interval (CI): 1.23-1.96, P = 0.0002]. Rates of non-accidental trauma (NAT) increased non-significantly (OR: 2.67, CI: 0.86-8.32, P = 0.0900) during 2020 (1.2%) relative to 2018 (0.6%) and 2019 (0.3%). Fractures occurring at home increased to 79.9% (OR: 6.44, CI: 5.04-8.22, P < 0.0001). Despite less overall trauma during shelter-in-place orders, greater fracture numbers were seen among younger children and severe fractures were likely among older children. Patients may hesitate to seek care during 2020. Rates of NAT doubled during 2020. As communities prepare for future waves, treatment centers should warn against common fracture mechanisms and raise awareness of NAT.


Subject(s)
COVID-19 , Fractures, Bone , Adolescent , Child , Fractures, Bone/epidemiology , Humans , Retrospective Studies , SARS-CoV-2 , Trauma Centers
12.
Ital J Pediatr ; 47(1): 142, 2021 Jun 30.
Article in English | MEDLINE | ID: covidwho-1286831

ABSTRACT

OBJECTIVE: To control the transmission of coronavirus disease 2019 (COVID-19), the Chinese government encouraged people to stay at home. This study aimed to evaluate the effects of home confinement on the occurrence of fractures among children. STUDY DESIGN: We retrospectively reviewed children admitted to Children's Hospital of Chongqing Medical University, for traumatic injury from January 24 to March 10, 2020, and the same time period in 2017, 2018 and 2019. At the same time, children with fracture were screened out and the date for the past 4 years was compared in terms of etiology, location of fracture, sex and age to evaluate the effects of home confinement on the epidemiology of pediatric fractures during the COVID-19 outbreak. RESULTS: There were 6066 fractures in5,346 patients in 2017-2019, and 1034 fractures in 862 patients in 2020; the number of patients in all years reached a peak at the age of 2 to 4 years. The patients were slightly younger in 2020 than in 2017-2019 (t = 9.953, 95% CI: 0.846-1.262), and the proportion of boys in 2017-2019 is higher than in 2020 (X2 = 6.944, P = 0.008). Home confinement and traffic restriction resulted in a reduction in traffic accidents-associated fractures among children (X2 = 16.399, P < 0.001). CONCLUSION: Home confinement lead to the significant reduction in the number of pediatric fractures, especially in male children, but the number of patients under 4 years old was still considerable, and the proportion of younger patients even increased. Therefore, the perspective of children should not be relaxed during home isolation.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Fractures, Bone/epidemiology , Physical Distancing , Adolescent , Child , Child, Preschool , China/epidemiology , Female , Humans , Infant , Male , Pandemics , Retrospective Studies , SARS-CoV-2
13.
Acta Orthop Traumatol Turc ; 55(3): 191-195, 2021 May.
Article in English | MEDLINE | ID: covidwho-1261416

ABSTRACT

OBJECTIVE: This study aimed to investigate whether various curfew practices affect trauma prevalence, epidemiological differences among the population admitted to hospital because of trauma, and treatment practices used after trauma. METHODS: Patients who suffered from fractures or soft-tissue trauma between March 21, 2020, and June 1, 2020, (group pandemic) and during the same period in 2019 (control group) were included in our single-center retrospective study. Each group was also divided into 3 subgroups according to the age of patients (≤ 20 years, 21-64 years, and ≥ 65 years). Data including anatomical region subjected to trauma, place of admission, mechanism of trauma, location of trauma, mode of treatment, type of surgery (if performed), duration of hospitalization (if hospitalized), time elapsed until surgery, and duration of postoperative hospitalization were collected and compared between groups. RESULTS: A total of 361 patients were admitted to the hospital with new trauma during the pandemic, and 708 patients had been admitted during the same period in 2019. The number of admissions decreased significantly by 50.9% (P < 0.001). The mechanism of trauma that occurred with low energy was significantly increased in the pandemic group (73.9%) compared with the control group (47.6%) (P < 0.001). Similarly, the distribution of trauma throughout the skeletal system, especially in the upper extremity, was significantly increased in the pandemic group (49.9% vs. 30.5%, P < 0.001). However, there was no significant decrease in individuals aged above 65 years (P = 0.115). Similar to the general outlook, the 3 groups differed in terms of the mechanism of trauma, location of trauma, and distribution of the anatomical region subjected to trauma (P < 0.001). Majority of the patients received inpatient treatment in all 3 groups (P < 0.001). CONCLUSION: The results of this study showed that the pandemic dramatically reduced the number of hospital admissions related to orthopedic trauma. The rate of low energy, upper extremity traumas that occurred indoors increased during the pandemic period compared with that of the previous year. However, the rate of hospital admissions did not differ in the ≥65-year-old subgroup during the pandemic period compared with that of the previous year.


Subject(s)
COVID-19 , Communicable Disease Control/methods , Fractures, Bone , Hospitalization/statistics & numerical data , Adult , Age Factors , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Child , Female , Fractures, Bone/epidemiology , Fractures, Bone/etiology , Fractures, Bone/therapy , Humans , Male , Prevalence , Retrospective Studies , SARS-CoV-2 , Tertiary Care Centers/statistics & numerical data , Turkey/epidemiology
14.
Ann R Coll Surg Engl ; 103(3): 167-172, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1154068

ABSTRACT

INTRODUCTION: We describe a new service model, the Orthopaedic Assessment Unit (OAU), designed to provide care for trauma patients during the COVID-19 pandemic. Patients without COVID-19 symptoms and isolated musculoskeletal injuries were redirected to the OAU. METHODS: We prospectively reviewed patients throughput during the peak of the global pandemic (7 May 2020 to 7 June 2020) and compared with our historic service provision (7 May 2019 to 7 June 2019). The Mann-Whitney and Fisher Exact tests were used to test the statistical significance of data. RESULTS: A total of 1,147 patients were seen, with peak attendances between 11am and 2pm; 96% of all referrals were seen within 4h. The majority of patients were seen by orthopaedic registrars (52%) and nurse practitioners (44%). The majority of patients suffered from sprains and strains (39%), followed by fractures (22%) and wounds (20%); 73% of patients were discharged on the same day, 15% given follow up, 8% underwent surgery and 3% were admitted but did not undergo surgery. Our volume of trauma admissions and theatre cases decreased by 22% and 17%, respectively (p=0.058; 0.139). There was a significant reduction of virtual fracture clinic referrals after reconfiguration of services (p<0.001). CONCLUSIONS: Rapid implementation of a specialist OAU during a pandemic can provide early definitive trauma care while exceeding national waiting time standards. The fall in trauma attendances was lower than anticipated. The retention of orthopaedic staff in the department to staff the unit and maintain a high standard of care is imperative.


Subject(s)
Delivery of Health Care/organization & administration , Fractures, Bone/therapy , Orthopedics/organization & administration , Sprains and Strains/therapy , Adult , Aged , Ambulatory Care/statistics & numerical data , COVID-19 , Emergency Service, Hospital , Environment Design , Female , Fractures, Bone/diagnosis , Fractures, Bone/epidemiology , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Nurse Practitioners , Orthopedic Procedures , Orthopedic Surgeons , SARS-CoV-2 , Scotland/epidemiology , Sprains and Strains/diagnosis , Sprains and Strains/epidemiology , Trauma Centers , Triage , Wounds and Injuries/diagnosis , Wounds and Injuries/epidemiology , Wounds and Injuries/therapy
15.
Ann R Coll Surg Engl ; 103(3): 160-166, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1110065

ABSTRACT

INTRODUCTION: The COVID-19 pandemic resulted in reconfiguration of the NHS. Elective services were stopped and trauma services focused on decreasing patient-clinician interactions and managing injuries nonoperatively wherever possible. The everyday life of the general public changed dramatically with the introduction of a national lockdown to prevent the spread of COVID-19. This paper looks at the experience of a South West London trauma unit. MATERIALS AND METHODS: All patients reviewed in fracture clinic and by the orthopaedic on-call team between 23 March to 23 April 2020 were included. Data on the mechanism of injury and whether this was a usual activity, the injury sustained and its management were collected. RESULTS: A total of 167 trauma injuries were seen, compared with 735 new patients with injuries in the previous month. The number of trauma operations completed decreased by 38%; 55% of injuries occurred inside the home and 44% outside the home during daily exercise. Some 31% of injuries were secondary to a new activity taken up during lockdown. Three open fractures and two polytrauma cases were seen that would have normally been managed at the local major trauma centre. CONCLUSION: Overall, both the number of injuries seen and trauma operations completed during the enforced lockdown decreased. This is probably due to a change in the way the general public are living their lives, and the reconfigurations within the NHS in response to the COVID-19 pandemic. This is an interesting time within trauma and orthopaedic departments, as they continue to adapt to the changing injuries and working environment.


Subject(s)
Accidents, Home/statistics & numerical data , Exercise , Fractures, Bone/epidemiology , Trauma Centers , Accidental Falls/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Bicycling/injuries , COVID-19/prevention & control , Child , Child, Preschool , Communicable Disease Control , Female , Femoral Neck Fractures/epidemiology , Femoral Neck Fractures/etiology , Femoral Neck Fractures/surgery , Fracture Fixation, Internal , Fractures, Bone/etiology , Fractures, Bone/surgery , Gardening , Humans , Infant , London/epidemiology , Male , Middle Aged , Radius Fractures/epidemiology , Radius Fractures/etiology , Radius Fractures/surgery , SARS-CoV-2 , Young Adult
16.
Injury ; 52(3): 395-401, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1087000

ABSTRACT

PURPOSE: The aim of this study was to evaluate changes in both mechanism and diagnoses of injuries presenting to the orthopaedic department during this lockdown period, as well as to observe any changes in operative case-mix during this time. METHODS: A study period of twelve weeks following the introduction of the nationwide "lockdown period", March 23rd - June 14th, 2020 was identified and compared to the same time period in 2019 as a "baseline period". A retrospective analysis of all emergency orthopaedic referrals and surgical procedures performed during these time frames was undertaken. All data was collected and screened using the 'eTrauma' management platform (Open Medical, UK). The study included data from a five NHS Foundation Trusts within North West London. A total of 6695 referrals were included for analysis. RESULTS: The total number of referrals received during the lockdown period fell by 35.3% (n=2631) compared to the same period in 2019 (n=4064). Falls remained proportionally the most common mechanism of injury across all age groups in both time periods. The proportion sports related injuries compared to the overall number of injuries fell significantly during the lockdown period (p<0.001), however, the proportion of pushbike related accidents increased significantly (p<0.001). The total number of operations performed during the lockdown period fell by 38.8% (n=1046) during lockdown (n=1732). The proportion of patients undergoing operative intervention for Neck of Femur (NOF) and ankle fractures remained similar during both study periods. A more non-operative approach was seen in the management of wrist fractures, with 41.4% of injuries undergoing an operation during the lockdown period compared to 58.6% at baseline (p<0.001). CONCLUSION: In conclusion, the nationwide lockdown has led to a decrease in emergency orthopaedic referrals and procedure numbers. There has been a change in mechanism of injuries, with fewer sporting injuries, conversely, there has been an increase in the number of pushbike or scooter related injuries during the lockdown period. NOF fractures remained at similar levels to the previous year. There was a change in strategy for managing distal radius fractures with more fractures being treated non-operatively.


Subject(s)
Accidental Falls/statistics & numerical data , Accidents, Traffic/trends , Bicycling/injuries , COVID-19 , Orthopedic Procedures/trends , Referral and Consultation/trends , Wounds and Injuries/epidemiology , Adolescent , Adult , Aged , Arm Injuries/epidemiology , Arm Injuries/etiology , Arm Injuries/therapy , Athletic Injuries/epidemiology , Athletic Injuries/therapy , Child , Child, Preschool , Diagnosis-Related Groups , Female , Femoral Neck Fractures/epidemiology , Femoral Neck Fractures/surgery , Fractures, Bone/epidemiology , Fractures, Bone/etiology , Fractures, Bone/therapy , Fractures, Open/epidemiology , Fractures, Open/etiology , Fractures, Open/therapy , Humans , Infant , Infant, Newborn , Leg Injuries/epidemiology , Leg Injuries/etiology , Leg Injuries/therapy , London/epidemiology , Male , Middle Aged , SARS-CoV-2 , Trauma Centers , Wounds and Injuries/etiology , Wounds and Injuries/therapy , Wrist Injuries/epidemiology , Wrist Injuries/etiology , Wrist Injuries/therapy , Young Adult
17.
PLoS One ; 16(2): e0246956, 2021.
Article in English | MEDLINE | ID: covidwho-1085151

ABSTRACT

BACKGROUND: The COVID-19 pandemic led to the implementation of drastic shutdown measures worldwide. While quarantine, self-isolation and shutdown laws helped to effectively contain and control the spread of SARS-CoV-2, the impact of COVID-19 shutdowns on trauma care in emergency departments (EDs) remains elusive. METHODS: All ED patient records from the 35-day COVID-19 shutdown (SHUTDOWN) period were retrospectively compared to a calendar-matched control period in 2019 (CTRL) as well as to a pre (PRE)- and post (POST)-shutdown period in an academic Level I Trauma Center in Berlin, Germany. Total patient and orthopedic trauma cases and contacts as well as trauma causes and injury patterns were evaluated during respective periods regarding absolute numbers, incidence rate ratios (IRRs) and risk ratios (RRs). FINDINGS: Daily total patient cases (SHUTDOWN vs. CTRL, 106.94 vs. 167.54) and orthopedic trauma cases (SHUTDOWN vs. CTRL, 30.91 vs. 52.06) decreased during the SHUTDOWN compared to the CTRL period with IRRs of 0.64 and 0.59. While absolute numbers decreased for most trauma causes during the SHUTDOWN period, we observed increased incidence proportions of household injuries and bicycle accidents with RRs of 1.31 and 1.68 respectively. An RR of 2.41 was observed for injuries due to domestic violence. We further recorded increased incidence proportions of acute and regular substance abuse during the SHUTDOWN period with RRs of 1.63 and 3.22, respectively. CONCLUSIONS: While we observed a relevant decrease in total patient cases, relative proportions of specific trauma causes and injury patterns increased during the COVID-19 shutdown in Berlin, Germany. As government programs offered prompt financial aid during the pandemic to individuals and businesses, additional social support may be considered for vulnerable domestic environments.


Subject(s)
COVID-19/epidemiology , Fractures, Bone/epidemiology , Quarantine/statistics & numerical data , Trauma Centers/statistics & numerical data , COVID-19/prevention & control , Fractures, Bone/classification , Fractures, Bone/etiology , Germany , Hospitals, University/statistics & numerical data , Humans
18.
Ann R Coll Surg Engl ; 103(2): 114-119, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1073077

ABSTRACT

INTRODUCTION: Non-injury-related factors have been extensively studied in major trauma and have been shown to have a significant impact on patient outcomes. Mental illness and associated medication use has been proven to have a negative effect on bone health and fracture healing. MATERIALS AND METHODS: We collated data retrospectively from the records of orthopaedic inpatients in a non-COVID and COVID period. We analysed demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient comorbidities, including psychiatric history. RESULTS: There were 824 orthopaedic referrals and 358 admissions (six/day) in the non-COVID period, with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared with 473 referrals and 195 admissions (three/day) in the COVID period, with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) having a fracture. DISCUSSION: There was a reduction in the number of admissions and referrals during the pandemic, but a simultaneous three-fold rise in admissions with a psychiatric diagnosis. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. CONCLUSION: While total numbers using the orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affects those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. It is imperative that adequate support is in place for patients with vulnerable mental health during these periods, particularly as we look towards a potential 'second wave' of COVID-19.


Subject(s)
COVID-19 , Fractures, Bone/epidemiology , Hospitalization/trends , Mental Disorders/epidemiology , Referral and Consultation/trends , Suicide, Attempted/trends , Adult , Alcoholism/epidemiology , Anxiety Disorders/epidemiology , Comorbidity , Depressive Disorder/epidemiology , Female , Foreign Bodies/epidemiology , Foreign Bodies/surgery , Fractures, Bone/surgery , Humans , Joint Dislocations/epidemiology , Joint Dislocations/surgery , London/epidemiology , Male , Mental Disorders/drug therapy , Orthopedic Procedures , Psychotropic Drugs/therapeutic use , Retrospective Studies , SARS-CoV-2 , Soft Tissue Injuries/epidemiology , Soft Tissue Injuries/surgery , Substance-Related Disorders/epidemiology , Wounds and Injuries/epidemiology , Wounds and Injuries/surgery
19.
Acta Biomed ; 91(14-S): e2020028, 2020 12 30.
Article in English | MEDLINE | ID: covidwho-1070033

ABSTRACT

INTRODUCTION AND AIM: The Coronavirus pandemic represents one of the most massive health emergencies in the last century. Aim of the study is to evaluate the trend of E.R. accesses and orthopaedic events during the pandemic of Covid-19. MATERIALS AND METHODS: we retrospectively analysed all data related to patients admitted to the E.R. Department of the Hospital of Piacenza from August 26th 2019 to August 23rd 2020, splitting this period on February 23rd 2020. RESULTS: Our analysis shows a reduction of -18.0% in E.R. accesses. We calculated a growth of deaths in the E.R. equal to +220%. Our orthopaedic pathway recorded a drop of -26.8%. Traumas occurred at home increased (+19.1%). We note an actual drop only on proximal femur fractures (weighted average of -17.7%), while all the others underwent an increase. DISCUSSION: The amount of E.R. accesses registered a drop -18.0%, while the pathway dedicated to emergency cases underwent an increase. The major complexity of clinical conditions influenced the number of hospitalizations and the fear of the infection increased hospitalization refusals. There has been a zeroing of school traumas, a reduction in sport, transfer home-work/work-home, work, roadside, injuries. Total amount of fractures strongly increase after the end of the lockdown. CONCLUSION: our data confirmed the decrease of retirement houses, sports, works and roadsides traumas and a zeroing of schools ones, while those occurred inside domestic environment underwent a consistent raise. We noticed a reduction in femur fractures and significant spread of all fractures after the end of the lockdown.


Subject(s)
COVID-19 , Emergency Service, Hospital/statistics & numerical data , Orthopedics/statistics & numerical data , Femur/injuries , Fractures, Bone/epidemiology , Health Services Accessibility/statistics & numerical data , Hospitalization , Humans , Italy , Pandemics , Retrospective Studies , Wounds and Injuries/epidemiology
20.
Acta Biomed ; 91(14-S): e2020001, 2020 12 30.
Article in English | MEDLINE | ID: covidwho-1068226

ABSTRACT

Limiting people's movement is one of the main preventive measures deployed for the control of coronavirus 2019­nCoV pandemic. This study aims to assess the impact of COVID-19 lockdown on the incidence of the most common skeletal injuries and to provide a management algorithm specific for hospitalized fractured patients.We comparatively analysed the Emergency Department (ED) admissions between March 9th and May 4th 2020 with the same period in 2019. The frequency of the most common skeletal injuries has been derived. Data from the pre-hospitalization phase to discharge of all patients were considered. The impact on clinical orthopaedic consulting has been evaluated. All patients requiring orthopaedic care followed different pathways of hospitalization based on COVID positivity. Data of surgical activity has been analysed.During the 9 weeks of lockdown the access of patients to ED drastically decreased: 11726 accesses compared to 21501 in the same period of 2019. This trend was followed by the most common skeletal injuries but not by proximal femur fracture (PFF) that showed the same absolute numbers compare to the previous years (64 vs 63). If analysed in relation to the total ED access, PFF showed a relatively increase in their frequency.The data from this experience suggest that healthcare providers should strategically allocate resources for management and treatment of PFF during the COVID-19 pandemic. With the begin of the reopening phase, a "rebound effect" for orthopaedic care was observed leading to delayed treatments with a potential overall increased morbidity.


Subject(s)
COVID-19 , Femur/injuries , Fractures, Bone/epidemiology , Aged , Aged, 80 and over , Emergency Service, Hospital , Female , Fractures, Bone/surgery , Hospitalization , Hospitals, University , Humans , Italy , Male , Pandemics , Retrospective Studies
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